Dysmenorrhea

DYSMENORRHEA

1)Definition=

                    -Painful menstruation of sufficient magnitude so as to incapacitate day to day activities.

2)Types=

a)Primary (Spasmodic)

i) Introduction-

-No indentificable pathology.

-Incapacitation- 15 to 20%

-Relief by- Oral contrceptives, NSAID's

ii) Cause of pain-

-Psychosomatic disorders.

-Abnormal anatomical aspects of myometrium.

-Abnormal physiological aspects of myometrium.

-Imbalance in autonomic nervous control of uterine muscles.

-Role of prostaglandins- Vasoconstrictor of myometrium

-Role of vassopressin- Vasoconstrictor of myometrium.

-Role of endothelins- Constrictor of myometrium.

iii) Clinical features-

-Pains begins with onset of menstruation.

-Severity last for 24 to 48 hrs.

-Pain confined to lower abdomen.

-Pain may radiate to back and medial aspects of thigh.

-Signs

-Nausea, Vomiting, Fatigue, Diarrhea, Headache, Tachycardia, Cold sweats, Fainting, Syncope, Collapse

iv)Treatment-

-General health improvement.

-Simple psycotherapy.

-Analgesic, antispasmodic may prescribe.

-Pethidine, morphine must not be suscribe.

-Drugs-

-NSAID's, Oral pills, Dydrogesteron.

-Orally for 2 to 3 days starting with the onset of menstruation.

-Continue for 3 to 6 cycles.

-Surgery-

-TENS- Transcutaneous Electric Nerve Stimulation.

-LUNA- Laproscopic Uterine Nerve Ablation.

-LPN- Laproscopic Presacral Neurectomy.

-Dilatation of cervical canal.

b)Secondary (Congestive)

i)Introduction-

- Menstruation associated pain occur in presence of pelvic pathology.

ii)Causes-

-Related to increasing tension in pelvic tissue.

iii)Patient profile-

-Patient in thirties.

-Parous.

iv)Clinical features-

-Dull pain.

-Situated in back and front.

-No radiation of pain.

-3 to 5 days prior to period.

-Relives with onset of bleeding.

-No systemic dyscomforts.

v)Investigations-

-Transvaginal sonography.

-Saline infusion sonography.

-Laproscopy

-Hysteroscopy

vi)Treatment-

-Depends upon severity, age and priority of patient.